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External information

Updated on June 16, 2021

The Pega Smart Claims Engine (SCE) for Healthcare 8.7 release enhanced third-party integration capabilities to request, receive, store, and send standard and supplemental claim information from an external system.

Using SCE’s GET, POST and PUT claims APIs, this information can be used for claim processing, workflow management, reporting and claim resolution.

Out of the box, the system supports intake of supplemental data such as system (system identifier), record type, code, field type, value, and code reason. This capability allows information such as codes representing errors, warnings, and overrides to be sent to SCE (from an external system). External information may be captured at the header and/or the line level.

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